Strategy for the treatment of chronic leg wounds: a new model in Poland

AIM

The aim of the present study was to implement and evaluate a system of care for patients with chronic leg ulceration (CLU) in Poland.

METHODS

All patients within two defined geographical areas in Poland were identified for inclusion in the study. A model of care was developed based on guidelines, including the appropriate education of health professionals treating patients, access to non-invasive methods to determine the ulcer aetiology, compression therapy in those with proven venous ulceration.

RESULTS

In total 309 patients were identified with CLU at the start of the study (120 men, 189 women). Both regions had a similar profile of patients having a median (IQR) duration of ulceration of 96 (30-168) months. Most (75.7%) patients were assessed using clinical signs and symptoms alone, with a mean (SD) number of treatments per week at 1.8 (1.9) visits. Two years after implementation, the numbers of patients had reduced to 205 (86 men, 119 women) a reduction of 33%. Post implementation more patients were treated at home (49.3% versus 19.5%) with a corresponding reduction in those seen at health centres (35.6% versus 63.3%). The mean (SD) number of visits was reduced to 1.3 (0.7). During implementation the healing rate at 30 weeks improved from 73.3% to 82.9%, with a corresponding reduction in amputations from 6.3% to 2.1%. While the cost per patient was higher post-implementation, the overall cost of treating patients within the service reduced from €3847 to €2913 per week.

CONCLUSION

The development and implementation of an evidence based system of care for patients with CLU in Poland is both clinically and cost effective. This may be used as a model for other regions of Poland.

Thyroid cancer morbidity in Opole province, Poland, after Czernobyl disaster

The Czernobyl disaster caused an extensive pollution in Europe due to the release into the environment thousands of tons of radioactive isotopes affecting the elevated cancer morbidity in the continent. The authors used the data set on radiation in Opole province, Poland, to model thyroid cancer incidence in the 1994-1998 quinquennium. An increase in thyroid cancer morbidity in females was observed within the 137 + 134Cs elevated concentration areas. The changes of the cancer incidence in males were found not significant for the distinguished radiation levels in the region. The statistical modeling was performed via the BUGS software.

Evaluating the competence of venous valves preserved with denaturation in cold ischaemia

AIM OF STUDY

The aim of this study was to evaluate the competence of venous valves preserved with denaturation in cold ischaemia.

MATERIAL AND METHOD

Eight segments of saphenous veins with 20 competent valves were analysed in the study. The material was collected during multiorgan retrievals. After harvesting, 15 cm long venous fragments were assessed with respect to valve presence. A 4-cm fragment with a valve was used for the analysis. Valve competence was assessed twice: after sampling and after 21 days of preservation. The valves were subjected to 136 cm water column pressure test. Denaturation in cold ischaemia consists of preservation of vessels at 4_C in a preservation medium containing antibiotics. Bacteriological and morphological examinations by light microscopy were performed.

RESULTS

After the preservation period, all the valves retained their mechanical properties. Well-preserved elastic elements of vascular wall were maintained in all vessels. Minor fragmentation of elastic fibres was observed and the structure of vascular wall was usually regular.

CONCLUSIONS

Our study indicates that denaturation in cold ischaemia allows for the maintenance of the properties and physiological functions of the valves after preservation. This effect is related to the good condition of elastic fibres, venous wall structure and the valve itself.

Six year experience with expanded polytetrafluoroethylene arterial grafts for limb salvage

We have used 822 polytetrafluoroethylene (PTFE) grafts in arterial reconstructions for limb salvage over the last 6 years at Montefiore Medical Center-Albert Einstein College of Medicine, Four hundred and twenty-seven femoropopliteal reconstructions with PTFE had a 6 year cumulative life table patency rate of 55% with follow-up of 76 grafts for more than 3 years and 28 grafts for more than 4 years. Seventy-nine bypasses to the isolated popliteal segment had a 6 year cumulative patency rate of 72%. There were 207 bypasses performed to the tibial, peroneal or dorsalis pedis arteries. Life table patency rates were 55% at 1 year, 40% at 2 years and 37% at 4 years. Ninety-two PTFE femorofemoral and 62 axillofemoral bypasses had 5 1/2 year cumulative life table patency rates of 83% and 75%, respectively. Axillopopliteal PTFE bypasses can salvage otherwise doomed limbs. Thirty-four such grafts had 74% 1 year and 45% 5 year patency rates. The overall infection rate in all 822 PTFE grafts was only 0.5%. Thus, PTFE is a promising vascular prosthetic material which facilitates otherwise difficult or impossible limb salvage procedures.